Monson Retirement Home

Updated 20 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors completed a site visit. An Expert by Experience made telephone calls to relatives to seek their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Monson Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. A new manager had been recruited and was due to commence in January 2022. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This was an unannounced inspection.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and a range of external professional who work with the service. We used all of this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with two people about their experience of living at the service. We spoke with two peripatetic managers, two senior care staff (day and night), two care staff, an agency cook, the senior housekeeper and a housekeeper. We also spoke to a visiting community nurse.

We reviewed a range of records. This included in part, six people's care records and multiple medication records. We looked at three staff files in relation to recruitment. We looked at a variety of records relating to the management of the service, including audits, checks and incident analysis.

After the inspection

Following the inspection site visit, the Expert by Experience contacted relatives by telephone and spoke with six people. Staff were contacted and invited to provide feedback about working at the service. We received three responses from care staff. We continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider's training data, policies, procedures, and meeting records.

Updated 20 November 2021

Monson Retirement Home is a residential care home providing accommodation and personal care for up to 50 older people, including people living with dementia. At the time of our inspection, there were 16 people living at the service.

People’s experience of using this service and what we found

People’s prescribed medicines were not consistently stored, administered, or managed safely. This put people at potential risk of harm.

A registered manager was not in place and the provider’s senior management team, had day to day responsibility of the service. A new deputy and manager had been recruited and were due to commence.

The provider had and continued to experience, staff recruitment and agency staff difficulties. The provider had taken all reasonable action to address these issues and some improvements had been made. Whilst the provider used a dependency tool to assess staffing requirements, concerns were identified with the safe staffing levels the provided had risk assessed for. The provider agreed to ensure the optimum staffing levels they had assessed as required were consistently met. Following the inspection, the provider submitted staff rotas to confirm this.

The provider had safe staff recruitment checks and staff received ongoing training and support.

Risks associated with people’s care needs had been assessed and were regularly monitored. A new electronic care record system was being introduced and people’s care plans and risk assessments were all being reviewed. A sample of the new care records were found to be more detailed and person centred. The provider had a short time scale to complete these reviews.

The provider had systems and processes that regularly monitored the health and safety of the premises, equipment, and the environment. Fire safety remedial action had been completed and some refurbishment and redecoration work had been completed since the last inspection and this was ongoing. Incidents were analysed for themes, patterns, and any lessons to reduce further risks.

Infection prevention and control measures overall followed best practice guidance. Some practice issues were identified in how soiled laundry and mop heads were managed. The provider took action to address this.

People who used the service, relatives and a visiting professional were overall complimentary about the approach of staff, who they described as being kind, caring and attentive. Concerns were raised about changes within the management team and people were looking forward to having a stable and effective management team.

The providers senior leadership team had day to day responsibility and development for the service. There was ongoing oversight with clear roles, responsibilities, and accountability. However, this needed to be improved upon within the staff team, to ensure the provider’s policies and procedures were consistently followed.

The provider had used and improved, systems and processes that monitored the safety and quality of the service. A robust improvement plan was in place that reflected the shortfalls identified during this inspection.

People, relatives and staff received opportunities to share their experience and feedback about the service. The provider took positive action in response to feedback received to make improvements.

Staff had developed positive partnerships with external health and social care professionals to support people to achieve positive outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 September 2020).

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Monson Retirement Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the management of people’s medicine at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.